1. Junior Doctors Hours - Sept 2003 Junior Doctors Hours – in 12 easy steps Jayn Ammantoola Medical Personnel Specialist / Project Manager for Junior Doctors Hours – Barts and the London

2. Junior Doctors Hours - Sept 2003 Painting the historical picture: 1990 and before: 1 in 2 on call; UMTs; shoe polishing; breakfast waiters; Thursday evenings off 1991: Heads of Agreement; ADHs; full & partial shifts; goodbye goodwill; EL(96)10: for those working on call, but at a partial shift intensity hours limits; HSC 1998/227: claims for intensity at full shift level, paid at Class 1… HSC 1998/240: rest defined; more intensity; negotiations between DoH and BMA; July 2000 – the NHS Plan – modernisation, -> Shifting the Balance of Power – April 01 and Jan 02 October / November 2000 – pay banding blue questionnaires Jan 2001 for December 2000: AL(MD)1/01

3. Junior Doctors Hours - Sept 2003 Banding – AL(MD)1/01 Band 2, and 1 – hours Band..a,..b – unsocial hours Band 3 – non compliant – punitive financial penalties for the Trusts Annual multiplier Mutual Obligations Allocating a band through the RAT It was aimed to be simple, fair, recognising intensity, unsocial hours, and would put an end to hours counting. Pensions changes – contributions assessed on 40 hours

4. Junior Doctors Hours - Sept 2003 Banding - Incentives & Sanctions Annual Pain - the multipliers Dec 2000, 2001, 2002 The mutual obligation – to ask and to do The clinical governance / tired doctors / non compliant doctors vs the service issues Disciplinary procedures for not monitoring RAT assistance Withdrawal of Educational approvals Stars

5. Junior Doctors Hours - Sept 2003 Practicalities - pay protection Para 32 – 39 of the circular AL(MD)1/01 The question – “When were you appointed?”. No cheating Compliance earlier – less pay protection problems later

6. Junior Doctors Hours - Sept 2003 Practicalities – in your Trust Board level backing ( not just lip service) Departmental “angels” Written work patterns Consultants genuine The training questions addressed seriously

7. Junior Doctors Hours - Sept 2003 August 2003 August 2003 – all SHOs and SpRs compliant How have we done so far? More Trust doctors A few nurse practitioners Some doctors “helpers” And next???

8. Junior Doctors Hours - Sept 2003 Next, Working Time Regs The European Working Time Directive is European law that was implemented into UK law in 1998. It is legislation designed to protect the Health & Safety of Workers

9. Junior Doctors Hours - Sept 2003 EWTR – key issues……. Reduce the overall weekly working hours for junior docs – first to 58 (well 56 actually – we’ll keep the New Deal rules here), and then to 48 hours by 2009. 11 hours rest in every 24 hours, from August 2004. Minimum rest of 24 hours each week. Rest break of 20 minutes per 4 hours of work. Paid holidays of 4 weeks per year.

10. Junior Doctors Hours - Sept 2003 EWTR – other issues SIMAP – the Spanish doctors who went to court – if you are resident on call in hospital, you are deemed to be working for the whole of the on call period (sleeping, watching TV, eating) Education – what time for teaching? Service delivery

11. Junior Doctors Hours - Sept 2003 Derogation? Derogation – to disapply or modify Cannot be done for targets but can be done for “soft” issues by national or local agreement. Workers will be given equivalent periods of compensatory rest. Article 3, (rest break 11/24) Article 4, (minimum rest 20 mins >6 hours) Article 7 (minimum rest 24 hrs in 7 days) Article 8, Night workers Article 16, (length of time for average hours: 1 year)

12. Junior Doctors Hours - Sept 2003 What to do? Implement new work patterns: 1.Use good monitoring data 2.Remove inappropriate duties 3.Plan for training, and service provision 4.Design it with the juniors 5.Implement with plenty of time to tweak and modify 6.Remonitor after 6 weeks. 7.Do all this before August 2004

13. Junior Doctors Hours - Sept 2003 What else to do? Think differently - in conjunction with all participants – transform (throw it all in the ring, mix, and see what comes out) Hospital at Night The Front Door (TIS) (see and treat) New working practices Skills escalator